Pulmonary ventilation in acute respiratory failure (ARF) is commonly geared to the recruitment of diseased lung through PEEP, and through the use of high airway pressures. We have now developed a new method of pulmonary ventilation that permits tidal volumes as low as 1 - 2 ml/kg, at respiratory rates from normal, to at least 120/min (Intratracheal Pulmonary Ventilation - ITPV). We have applied ITPV in the treatment of ARF in a sheep animal model, with low tidal volumes and normal peak airway pressure, and at a high respiratory rates, with eventual recovery. We believe future ventilatory care likely will include ITPV, at volumes and pressures shown not to cause underlying acute disease processes. We have developed a line of ultra-thin walled, spring-wire reinforced endotracheal tubes that exhibit airflow resistance equal to, or lower, than that found in healthy man. The key feature is a wall thickness of about 0.175 mm, and a two-stage design, with a moderately larger diameter within the oropharynx. A distal section of the endotracheal tube approximates a triangular shape, following the internal anatomy of the voice box. Instead of conventional cuffs, a series of soft "gills" provide a "no pressure seal", potentially greatly reducing morbidity associated with prolonged endotracheal intubation.